EFFICACY OF COMBINED THERAPEUTIC EXERCISE AND PSYCHOLOGICAL INTERVENTIONS ON DISABILITY OUTCOMES: A SCOPING REVIEW

Abstract The goal of therapeutic exercise (i.e., physical activity/exercise programs, physical therapy, rehabilitation), restoring and maintaining function in older adults (≥60 years), is hindered by personal factors (e.g., low self-efficacy) impacting exercise engagement. Combining therapeutic exercise with psychological interventions is a promising solution for maximizing treatment benefits. The purpose of this scoping review is to systematically synthesize the knowledge of randomized controlled trials (RCTs) testing combined therapeutic exercise and psychological interventions targeting disability outcomes in older adults. A comprehensive review of the literature, searching four databases, was performed following PRISMA-ScR guidelines. Articles (n=4,995) underwent iterative screening, resulting in 31 RCTs. The World Health Organization’s International Classification of Functioning, Disability, and Health (ICF) model was utilized as a conceptual framework. Studies assessed at least one major domain of the ICF model: Body Function and Structure was an outcome in 67.74% of RCTs and both Activity and Participation were an outcome in 77.42% of RCTs. Personal factors were assessed in 64.52% of RCTs. Psychological interventions utilized were cognitive-behavioral (32.26%), motivational interviewing (29.03%), meditation (12.90%), or other (32.26%). Combined interventions compared to either therapeutic exercise alone (25.81%) or control (74.19%) demonstrated greater efficacy on at least one major ICF outcome in 77.42% of RCTs. This review indicates that incorporating psychological interventions within therapeutic exercise can maximize treatment benefits in older adults across diagnoses and setting. Future research is needed to better understand which psychological interventions demonstrate greatest efficacy when paired with therapeutic exercise within certain patient subgroups, in order to guide best practice guidelines.


Center University of
Increased longevity is a widespread worldwide trend, evidenced by demographic and epidemiological data, especially with regard to females, who live an average of seven years longer than males.The aging process is associated with a progressive decline in muscle mass, strength, power, impaired balance, altered heart function and vascular function.These changes negatively affect exercise capacity, increase the risk of cardiovascular disease, and have implications for physical function and the risk of falling.This is particularly relevant among women diagnosed with impaired functional performance.The aim of this study was to determine an association of biochemical, anthropometric, metabolic and inflammatory parameters according to the functional performance of older women aged 62 to 75 years attended for in primary health care.Statistical results showed that the 116 older women (56.86%) identified with impaired functional performance had a pro-inflammatory marker, high anthropometric indices and body composition, impaired cognitive performance and lower muscle strength as older women ( 88 ) with normal functional performance (43.14%).Age, waist-to-height ratio and elevated IL-6 and muscle strength significantly decreased the risk of impaired functional performance.These important findings demonstrate the need for further research documenting the underlying processes and risk factors for preserving functional capacity, carrying out life activities and decreasing the emergence of illnesses.The potential benefits of this approach provide a basis for developing individualized health promotion interventions in the management of this population of older women.Orthopedic walking boots (OWB) are an alternative to casting and immobilizing an injured ankle.Unfortunately, OWB causes a change in leg-length and pelvis angle which alters gait and postural stability and can lead to chronic back pain.Immobilizing the ankle without changing leg-length would be beneficial, especially for individuals with impaired gait and postural stability.The purpose of this study was to assess level-ground walking and stair negotiation in healthy older adults across three ankle support conditions (1) OWB, (2) TayCo ankle brace (TAB) and (3) athletic footwear (SHOD).Sixteen older adults (69+/-7.0years) performed 2-3 trials of walking, stair ascent, and stair descent using each of the three ankle support conditions.Ankle motion in all three planes was monitored using 3D motion capture cameras to assess differences during walking and stair negotiation.For all tasks, significant differences were revealed between the SHOD and both ankle support methods for all three planes (p < .001).Significant differences were also revealed between OWB and TAB during walking in the transverse plane (abd/ adduction) (p = .036OWB>TAB) and for stair descent in the sagittal plane (dorsi/plantarflexion) (p = .001TAB>OWB).
No other differences were observed between the OWB and TAB for walking or stair negotiation.Ankle motion was similarly controlled with both the OWB and TAB indicating that either method would be appropriate to immobilize an injured ankle, however the TAB does not alter leg length or pelvic tilt since it fits over the individual's footwear.(2011)(2012)(2013).Marginal standardization following generalized linear modelling (log-link, negative-binomial) was used to investigate whether cardiovascular features (hypertension, diabetes, BMI, smoking, heart disease, heart failure, stroke) helped explain race differences by comparing unadjusted (total effect) versus adjusted (direct effect) results.Among 5,836 participants (>65 years, mean age=75.9,42% men, 22% Black), Black participants scored 1.3 points lower than White participants; unadjusted: 8.2 versus 9.5; relative difference of 0.86 (0.84, 0.88).After accounting for cardiovascular features, Black participants scored 1.4 points lower than White participants; adjusted: 8.2 versus 9.6; relative difference of 0.85 (0.84, 0.87).Cardiovascular risk factors and disease alone did not appear to account for substantial cross-sectional physical performance race differences in this population.Future research should examine additional factors potentially contributing to observed functional differences typically attributed to race such as cumulative vascular risk factors, geographic, social, cultural, and other systemic influences.
Abstract citation ID: igad104.2456Older adults who experience a slip, trip, or fall may experience preclinical mobility limitation (PCML), where individuals report modifications but not difficulty in mobility tasks and are at increased risk for future functional decline.Functional decline may be prevented with exercise.The purpose of this pilot trial was to determine the feasibility (adherence, recruitment, retention, safety) and preliminary outcomes (physical functioning, cognitive functioning, enjoyment) of home-based 12-week high-intensity functional strength training (HIFST) for community-dwelling older adults (≥ 55 years) with PCML who have had an injury from a slip, trip, or fall in the previous year.The trial is currently underway (target completion spring 2023).Participants are stratified by sex and randomized (1:1) to HIFST or a stretching program, both delivered by a physiotherapist via videoconferencing.Feasibility will be assessed based on predetermined criteria and reported using descriptive statistics.Preliminary effects will be reported as between group differences.To date, 20 participants (11 HIFST, 9 stretch) have enrolled (target n=24).Six participants have completed the HIFST intervention, and 2 have withdrawn before completion (reasons: mental health crisis and acute knee pain episode) with a total adherence rate of 85.8% of sessions completed (97.7% for the 6 participants who did not withdraw) which exceeds our threshold for feasibility (≥ 70%).No serious intervention-related adverse events have been reported.The results of this pilot will provide essential information for future research regarding the process, resources, and potential effects of home-based HIFST in a PCML post-injury older adult population.

EFFICACY OF COMBINED THERAPEUTIC EXERCISE AND PSYCHOLOGICAL INTERVENTIONS ON DISABILITY OUTCOMES: A SCOPING REVIEW
Abstract citation ID: igad104.2458

GAIT ANALYSIS OF ELDERLY PEOPLE IN ANGOLA: COMPARISON BETWEEN ESTABLISHED ROUTE AND VIRTUAL REALITY AND TIME UP AND GO
Rita Barbara 1 , and Natália Luanda 2 , 1. Universidade de Aveiro,Sao Paulo,Sao Paulo,Brazil,2. Upra,Luanda,Luanda,Angola Background: Aging limits physical and mental abilities, particularly gait, compromising quality of life and increasing the risk of falls, which is a public health challenge in Angola.Technologies, such as virtual reality, may offer a promising alternative for treatment and prevention of these limitations.Objective: This study aimed to analyze the gait of elderly individuals in Angola by comparing gait on an established course and in a virtual environment, using motion analysis software and SPSS for statistical analysis with a p>0.05.Methods: Seven elderly individuals, aged 60-80, participated in the study.Gait was evaluated using the Timed Up and Go (TUG) test, an established course, and gait in a virtual environment.Results: Statistically significant differences were found between gait on the established course and in virtual reality, with elderly individuals showing slower and more variable gait in the virtual environment.There were also significant correlations between gait and TUG, highlighting the importance of motor coordination and balance in elderly gait.Conclusion: Gait analysis in elderly individuals can be performed precisely and stably through virtual reality technology.The results of this study suggest that virtual reality may be an interesting alternative for the treatment and prevention of falls in the elderly.The findings also emphasize the importance of motor coordination and balance in gait and the need for further research on the use of virtual reality technology in this population.

MEASURING ANKLE FLEXIBILITY IN OLDER HOME CARE RECIPIENTS WITH DISABILITIES IN THEIR HOME SETTING Jordan Skowronski, University of Illinois Chicago, Chicago, Illinois, United States
Ankle flexibility is critical for daily activities, such as climbing stairs.Ankle range of motion (AROM), or the range through which the ankle joint can bend up and down, decreases with age.Thus, interventions to improve or maintain AROM is an important goal in geriatric rehabilitation.Evaluating the outcome of such interventions requires AROM measures.However, existing measures either require large equipment or for the participant to stand and , B. Gwen Windham 2 , Hunter Sylvester 2 , Priya Palta 3 , Laura Skow 4 , A. Richey Sharrett 4 , Anna Kucharska-Newton 3 , and Michael Griswold 2 , 1. University of Mississippi School of Medicine, Jackson, Mississippi, United States, 2. UMMC-The MIND Center, Jackson, Mississippi, United States, 3. UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, United States, 4. Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States Older Black adults are reported to have poorer physical function relative to White older adults.Cardiovascular risk factors and disease are associated with physical function and are more prevalent in Black adults.We examined objective physical function cross-sectionally using the Short Physical Performance Battery (SPPB, scored 0-12; 0.5 is considered clinically meaningful) in the Atherosclerosis Risk in Communities Study among Black and White participants during Visit 5

FEASIBILITY OF HIGH-INTENSITY FUNCTIONAL STRENGTH TRAINING AT HOME FOR POSTINJURY OLDER ADULTS
Grace Rose 1 , Pietra Bruni 2 , Mariana Wingood 3 , Selmi Kallmi 4 , Elizabeth Finer 5 , and Patricia Bamonti 1 , 1.VA  Boston Healthcare System, Boston, Massachusetts, United  States, 2. VA Boston, Boston, Massachusetts, United States,  3. Wake Forest University, North Carolina,  United States, 4. Hines VA, Hines, Illinois, United States, 5.  HofstraUniversity, Hempstead, New York, United States Disability, and Health (ICF) model was utilized as a conceptual framework.Studies assessed at least one major domain of the ICF model: Body Function and Structure was an outcome in 67.74% of RCTs and both Activity and Participation were an outcome in 77.42% of RCTs.Personal factors were assessed in 64.52% of RCTs.Psychological interventions utilized were cognitivebehavioral (32.26%), motivational interviewing (29.03%), meditation (12.90%), or other (32.26%).Combined interventions compared to either therapeutic exercise alone (25.81%) or control (74.19%) demonstrated greater efficacy on at least one major ICF outcome in 77.42% of RCTs.This review indicates that incorporating psychological interventions within therapeutic exercise can maximize treatment benefits in older adults across diagnoses and setting.Future research is needed to better understand which psychological interventions demonstrate greatest efficacy when paired with therapeutic exercise within certain patient subgroups, in order to guide best practice guidelines.